[Criteria of diagnosis of left segmental blocks without axial deviation, in the presence of myocardial infarct].
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Biomedical subjects
Publications and source records attributed to C Ribeiro.
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Using the Dürrer electrode needle to record the intramural electrogram and a standard peripheral electrocardiogram (ECG) lead as reference, the authors studied the action of 9 different drugs in the conduction system of dogs. The authors concluded that diphenylhydantoin and lignocaine would be useful in dysrhythmias related to increased excitability and perhaps increased automatism. Ajmaline and quinidine may be some of some interest in dysrhythmias due to conduction disturbances; and, finally, ajmaline, diphenylhydantoin, di-isopyramide and quinidine may be useful in dysrhythmias due to focal re-entry.
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Hypertrophic Olivary Degeneration is a type of transneuronal degeneration caused by lesions in the dento-rubro-olivary pathway. It involves the inferior olivary nucleus and is a unique type of degeneration because it is associated with hypertrophy of this nucleus. The authors report MRI findings in 10 patients with Hypertrophic Olivary Degeneration, whose exams were reviewed.
The authors consider some clinical and radiological aspects of spontaneous intracranial hypotension syndrome, based on the knowledge obtained from three clinical situations. Postural headache was a constant complaint. In all cases, magnetic resonance imaging data obtained was diffuse dural enhancement and, in two cases, bilateral subdural fluid collections. The increasing recognition of this syndrome led to its distinction from meningeal inflammatory or neoplasic conditions, sparing the patient from unnecessary investigation.
The authors describe their experience with three-dimensional (3D) MRI reconstructions of the cerebral cortex in neurosurgical planning of cortical and subcortical lesions. The majority of the lesions were located on the cerebral hemispheres; there were also few cases of posterior fossa lesions. The authors selected three clinical cases to demonstrate the interest of 3D MRI. The authors describe another image processing method based on the three dimensional models obtained by using Curvilinear Multiplanar Reformatting (CMR) for the identification of subtle focal dysplastic lesions in patients with epilepsy. The advantages and disadvantages of those 3D MRI reconstructions methods are discussed and a comparison with conventional cross-sectional images is mentioned. The main disadvantages are the raw data relative to long acquisition time and the difficulty in sometimes establishing the cleavage plane between the cortex and extra-axial structures (e.g. young patients; lesions with great mass effect; lesions ventrally located in the cerebral lobes). In conclusion, the 3D MRI reconstructions of the cerebral cortex reveal additional information to conventional cross-sectional images and permit a precise location of the lesions. This is essential in some circumstances for neurosurgical planning and strategy, improving neurosurgical performance and patient outcome.
We review the pathophysiology, clinical features and therapy of acute thyroiditis. Four cases are reported stressing the role of fine needle aspiration for the diagnosis of this clinical entity.
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AIMS: To determine the incidence of different morphological type of myocardial laceration (wall rupture) in patients who died of acute myocardial infarction, as well as to study the several clinical forms of presentation of different types of myocardial laceration. CONCEPT OF THE STUDY: To apply a protocol of prospective study, that includes 64 clinical and 34 anatomical parameters, using very discriminative technics in the anatomical study, already presented in previous papers. PLACE OF THE STUDY: The study took place in a CCU and pathological department of a University Hospital. POPULATION: Of 1308 patients successively admitted in a CCU with acute myocardial infarction between 1983-1986, 252 have died. It was possible to perform a necropsy study in 193. The only criterion for inclusion was the family agreement. METHODS: The study was a prospective one, being excluded only the patients in whom the anatomical study didn't confirm recent myocardial infarction. The clinical data were observed during the stay in the CCU, using a protocol developed for this study. In the anatomical study a protocol developed by the authors was applied, using very discriminative anatomical quantification technics of the infarct size as well as of the coronary obstruction degree by atherosclerotic plaques. In the study of the myocardial laceration a fourteen septal perpendicular cuts technic was applied, with a laceration development macroscopic study, and microscopic study of the more interesting cuts. All data were stored and treated in a computer program developed for this study. RESULTS: From the 193 cases that have been studied, 49 presented a complete free wall rupture (25%) and in two others there were an interventricular septal rupture and free wall rupture. The amount of free wall rupture was then 51 cases (26%), with a corrected incidence for the population with AMI of 5.1%. In 7 cases we found an interventricular septal rupture (in two cases associated with complete free wall rupture and in other two cases with an incomplete left ventricular rupture), what represents an incidence in necropsy of 3.6%. Since that in this period five patients with septal rupture have been operated and in three others the hemodynamic diagnosis was made, dying this patients without being performed necropsic study, the amount of septal ruptures was of 15 cases, what represents a corrected incidence of 1.1% in the population with AMI. The clinical forms of presentation of free wall rupture were the following: syncope followed by death (60%), shock (21%), transitory syncope (4%), psycho-motor troubling (4%). Pain persistence or recurrence associated with other clinical symptoms occurred in 63% of the patients. Hypotension, not always evoluting to shock, occurred in 33%, and pericarditis in 21% of the cases. When the different anatomical types of free wall rupture were considered (type I-direct rupture; type II-multicanalicular rupture; type III-rupture covered by an interventricular thrombus), we observed that in type I there was prevalence of syncope (71% and only 50% showed pain persistence or recurrence, when in type II syncope occurred in 67% and shock in 22%, with pain in 56%, and in type III the occurrence of syncope and shock were similar (44% vs 38%), with pain in 81% of the cases. Hypotension was verified in 56% in type III, 21% in type I and 22% in type II. Pericarditis never occurred in type I, happened in 33% in type II and 25% in type III. The terminal accident took an average 44 minutes long in type I, 3.8 hours in type II and 9.2 hours in type III. The delay in admission was nine hours in type I, 19 in type II and 30 in type III, and the time between the onset of symptoms and death was 2.9, 2.7 and 5.4 days respectively in types I, II and III. In what concerns the interventricular septal rupture shock occurred in all cases but one, in which association with free wall rupture determined cardiac tamponade with syncope.(ABSTRACT TRUNCATED AT 400 WORDS)
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